In an ailing economy, the doctor can wait

Share via

Dena Lansford, 49, would like to have a cholesterol check, a mammogram and, soon, a colonoscopy.

She hasn’t seen a dentist in more than a year. She worries that she might suffer a similar fate as her mother, who had a stroke at 47.

But after losing her job and health insurance last year, the Wildomar woman said, “I’m not doing any preventive care.”


As of February, an estimated 3.7 million working-age Americans -- 500,000 in California -- had lost their health insurance since the start of the economic decline, according to a recent report.

People are cutting back on routine screenings and examinations designed to protect their health, Southern California doctors and dentists say.

Those who have health insurance with high deductibles or expensive co-pays also appear to be cutting back on nonessential medical care, doctors say, possibly to save money.

“People are spending less money on everything,” said Dr. Howard R. Krauss, president of the Los Angeles County Medical Assn. “If you’re feeling well, the easiest thing to save money on is not going in for your mammogram or colonoscopy.”

Precise numbers on the recession’s effect on preventive care are not yet available, but mammography screenings have declined in recent years, according to the American Cancer Society. They are down about 4% since 2000 and down 7% in women ages 50 to 64, the age group at highest risk for breast cancer.

Local dental practices say business is off 15% to 30% this year. Michael Fulbright, a Redondo Beach dentist, said his hygienists’ workloads had declined 15% in the last month.


A survey of Californians released last month by the California HealthCare Foundation found that 43% of people under 50 said they had postponed care for a chronic health condition because of cost.

Doctors in hospital emergency rooms say they are seeing signs that people are cutting back on routine care.

“People are coming in sicker, often with a chronic disease which had been under control but has gone out of control,” said Dr. Brian Johnston, medical director of the emergency department at White Memorial Medical Center in East Los Angeles. “Emergency rooms all over L.A. are reporting that patients are coming in, and they just can’t get to them fast enough.”

Preventive care includes examinations and tests to detect illness early and keep chronic health conditions -- such as asthma, diabetes, thyroid or blood pressure problems -- under control.

Though such care isn’t urgent, skipping it could have serious consequences, including cancers caught late when they could have been detected early, or high blood pressure culminating in a stroke when it could have been controlled.

“What we can confidently say is that people will die because of this economic downturn,” said Dr. Andrew Wilper, an instructor of internal medicine at the University of Washington.


He said the demand on Veterans Affairs hospitals was also increasing as more people lost private health insurance.

Most laid-off workers of low or moderate incomes can’t afford to keep their insurance through COBRA (the federal law that allows employees to keep their job-based health insurance for three years after they lose or leave a job, if they pay the entire premium) and do not qualify for public health programs for the poor.

A study by Wilper published in August in the Annals of Internal Medicine estimated that about 25% of uninsured adults had chronic health conditions such as diabetes or emphysema but did not receive regular care to ensure the conditions were well-managed. Twenty-two percent said they had not seen a doctor in the last year, compared with 6% of insured people.

Another study, published last month in the Archives of Ophthalmology, found that 14% of people without health insurance had seen an eye doctor in the last year.

Skipping routine care can allow small problems to become bigger.

An 11-year study in San Francisco found breast cancer tumors were more likely to be diagnosed at an advanced stage during periods of high unemployment.

Kimberly Ragucci, a graphic designer, has a high-deductible health plan that pays for expenses only after she has spent $5,000 in a year.


The 23-year-old mother, who lives in Long Beach, doesn’t have dental or vision insurance. She takes her son for regular pediatric care, but barring a medical emergency, she said she didn’t plan to seek healthcare for herself any time soon.

“I have astigmatism, and I need a new prescription,” she said. “I haven’t been to the eye doctor for more than two years. And ever since I got pregnant, my teeth have moved a lot. I know I need to see a dentist, but I can’t afford it.”

More than 17% of Americans under 65 have high-deductible plans like Ragucci’s, the Centers for Disease Control and Prevention said.

The average deductible for employer-sponsored high-deductible plans was $1,923 for single policies and $3,883 for family policies in 2007, according to the Kaiser Family Foundation and the Health Research & Educational Trust.

Under such plans, people pay out of pocket for routine or minor medical care. Insurance reimbursement only applies when they meet deductibles of several thousand dollars. That means patients will be less likely to go to the doctor even if they have chronic conditions that need to be tracked, Krauss said.

“It will undoubtedly lead to delays in diagnoses for diabetes, hypertension, glaucoma,” he said. “That’s the natural consequence of people not taking care of themselves.”


Co-pays have also increased in recent years, from an average of $15 in 2002 to $19 in 2005, according to the Agency for Healthcare Research and Quality.

That may bar people from getting cost-effective care, said Ashley B. Coffield, a senior fellow at the Partnership for Prevention, a Washington-based organization that promotes preventive health.

A co-pay of as little as $10 can prevent a woman from getting a mammogram, according to a study published last year in the New England Journal of Medicine. Many other studies have shown that prescription drug co-pay increases of as little as $5 can dissuade older patients from filling prescriptions.

Johnston encouraged people to view their health like they do any valuable possession and consider a visit to the doctor, even if they have to pay out of pocket.

“I say to patients, ‘If the transmission fails in your car, you would put out money to fix that,’ ” he said. “ ‘Your heart, kidneys and brain are more valuable than your car.’ ”